What causes COPD?

Although the most common cause of COPD is tobacco smoke, there are several other factors that can cause or make COPD worse, including
environmental exposures and genetic (inherited) risk. For example, heavy exposure to certain dusts at work,
chemicals, and indoor or outdoor air pollution (including wood smoke or biomass fuels) can contribute to COPD. Some people
have none of these exposures and still get COPD. We don’t fully understand why some smokers never develop COPD and some never smokers get
COPD; but, hereditary (genetic) factors probably play a role in who develops COPD.

ETIOLOGY
Smoking and pollutants
Host factor
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that
is characterized by persistent respiratory symptoms and airflow limitation that is due to airway
and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
The chronic airflow limitation that is characteristic of COPD is caused by a mixture of small airways
disease (e.g., obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative
contributions of which vary from person to person
Worldwide, the most commonly encountered risk factor for COPD is tobacco smoking. Other types
of tobacco, (e.g. pipe, cigar, water pipe) and marijuana are also risk factors for COPD. Outdoor,
occupational, and indoor air pollution – the latter resulting from the burning of biomass fuels – are
other major COPD risk factors.
Nonsmokers may also develop COPD. COPD is the result of a complex interplay of long-term
cumulative exposure to noxious gases and particles, combined with a variety of host factors
including genetics, airway hyper-responsiveness and poor lung growth during childhood.3-5
Often, the prevalence of COPD is directly related to the prevalence of tobacco smoking, although in
many countries outdoor, occupational and indoor air pollution (resulting from the burning of wood
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3
and other biomass fuels) are major COPD risk factors.6,7
The risk of developing COPD is related to the following factors:
• Tobacco smoke - including cigarette, pipe, cigar, water-pipe and other types of
tobacco smoking popular in many countries, as well as environmental tobacco smoke
(ETS)
• Indoor air pollution - from biomass fuel used for cooking and heating in poorly vented
dwellings, a risk factor that particularly affects women in developing countries
• Occupational exposures - including organic and inorganic dusts, chemical agents and
fumes, are under-appreciated risk factors for COPD.6,8
• Outdoor air pollution - also contributes to the lungs’ total burden of inhaled particles,
although it appears to have a relatively small effect in causing COPD.
• Genetic factors - such as severe hereditary deficiency of alpha-1 antitrypsin (AATD).9
• Age and gender - aging and female gender increase COPD risk.
• Lung growth and development - any factor that affects lung growth during gestation
and childhood (low birth weight, respiratory infections, etc.) has the potential to
increase an individual’s risk of developing COPD.
• Socioeconomic status - there is strong evidence that the risk of developing COPD is
inversely related to socioeconomic status.10 It is not clear, however, whether this
pattern reflects exposures to indoor and outdoor air pollutants, crowding, poor
nutrition, infections, or other factors related to low socioeconomic status.
• Asthma and airway hyper-reactivity - asthma may be a risk factor for the development
of airflow limitation and COPD.
• Chronic bronchitis - may increase the frequency of total and severe exacerbations.
• Infections - a history of severe childhood respiratory infection has been associated with
reduced lung function and increased respiratory symptoms in adulthood

WHAT CAUSES COPD?

Worldwide, the most commonly encountered risk factor for COPD is tobacco smoking. Nonsmokers
may also develop COPD. COPD is the result of a complex interplay of long-term cumulative exposure
to noxious gases and particles, combined with a variety of host factors including genetics, airway
hyper-responsiveness and poor lung growth during childhood. 3-5 The risk of developing COPD is
related to the following factors:

► Tobacco smoke – cigarette smokers have a higher prevalence of respiratory symptoms and
 lung function abnormalities, a greater annual rate of decline in FEV1, and
a greater COPD mortality rate than non-smokers.6 Other types of
tobacco (e.g., pipe, cigar, water pipe)7-9 and marijuana10 are also risk
factors for COPD, as well as environmental tobacco smoke (ETS). 11

► Indoor air pollution – resulting from the burning of wood and other
biomass fuels used for cooking and heating in poorly vented dwellings,
is a risk factor that particularly affects women in developing countries.
12,13

► Occupational exposures – including organic and inorganic dusts, chemical

agents and fumes, are under-appreciated risk factors for COPD. 12,14

►Outdoor air pollution – also contributes to the lungs’ total burden of inhaled particles,

although it appears to have a relatively small effect in causing COPD.

► Genetic factors – such as severe hereditary deficiency of alpha-1

antitrypsin (AATD) 15 ; the gene encoding matrix metalloproteinase 12
(MMP-12) and glutathione S-transferase have also been related to a
decline in lung function16 or risk of COPD.17

►Age and sex – aging and female sex increase COPD risk.

► Lung growth and development – any factor that affects lung growth during
gestation and childhood (low birth weight, respiratory infections, etc.) has
the potential to increase an
individual’s risk of developing COPD.

► Socioeconomic status – Poverty is consistently associated with airflow

obstruction18 and lower socioeconomic status is associated with an
increased risk of developing COPD.19,20 It is not clear, however, whether
this pattern reflects exposures to indoor and outdoor air pollutants,
crowding, poor nutrition, infections, or other factors related to low
socioeconomic status.

►Asthma and airway hyper-reactivity – asthma may be a risk factor for the
development of airflow limitation and COPD.

►Chronic bronchitis – may increase the frequency of total and severe exacerbations.21
►Infections – a history of severe childhood respiratory infection has been associated with reduced lung
function and increased respiratory symptoms in adulthood.